Thoracic Kyphosis: When Is Surgery Necessary?

March 30th, 2020

Thoracic kyphosis occurs when there’s an excessive curve of the thoracic spine, producing a hump in the mid back and a forward stooping posture. According to the journal Neurosurgery, this condition may be experienced by 20 to 40 percent of the elderly, especially among women between the ages of 50 to 70.

According to the American Academy of Orthopaedic Surgeons, the majority of cases do not require treatment but some patients may prefer to wear a back brace and do regular exercises for posture improvement.

However, our spine surgeon in Palm Beach County explains that for thoracic kyphosis patients who experience worsening curvature, increasing pain, or decreasing function surgical treatment can reliably correct the curve and restore posture and function.

Surgery for Thoracic Kyphosis

The first step in treating kyphosis involves a thorough history and physical examination with a fellowship trained orthopaedic spinal deformity surgeon to determine the cause for the kyphosis. Causes included congenital kyphosis and Scheurmans kyphosis in children and adolescents, fractures and degenerative conditions in the adult population, and osteoporotic compression fractures in the elderly. Most of these conditions can be treated with a structured exercise and spinal rehabilitation program improving strength and posture. Patients with progressive curves or disabling pain may require surgical management.

One of the most common causes of painful kyphosis is an osteoporotic fracture in the elderly. Patients with persistent disabling pain or progressive kyphosis can be treated with a kyphoplasty, a minimally invasive outpatient procedure.

Patients with a regional deformity involving the cervical thoracic or lumbar spine usually require a more involved reconstruction of the kyphotic segments. These procedures often require spinal osteotomies to release fixed deformity, spinal instrumentation to correct the curve, and spinal fusion to stabilize the correction.

Spinal decompression

If there are stenotic lesion compressing the spinal cord or spinal nerve roots a spinal decompression may be necessary prior to correcting the kyphosis. This aims to relieve the pressure on the nerve roots found in the spine and prevent neurologic injury during spinal realignment and kyphosis correction. Spinal decompression may involve various techniques including laminectomy, discectomy, and vertebral resection (Pedicle subtraction osteotomy).

Laminectomy entails removing the lamina of the vertebral bone in the roof of the spinal canal.

Discectomy removes an abnormal disc that compresses the spinal cord.

Vertebral Resection (PSO/vertebrectomy) involves removal of some or all of a vertebral body.

Surgical Risks for Thoracic Kyphosis

The decision to proceed with surgical treatment is made only after a thorough course of appropriate non operative care has failed to improve pain and function. A detailed and comprehensive evaluation with a fellowship trained orthopaedic spinal deformity surgeon can best determine the pros and cons of surgical treatment and select the techniques to best correct the under lining pathologies.

Post-surgery expectations include a short period of brace immobilization followed by a structure physical therapy and spine rehabilitation program to improve motion, flexibility, strength and function.

Significant improvements may be felt within three to six months post-surgery but different patients have different recovery timelines. Patients are also advised to attend their follow-up appointments to monitor the recovery.

If you are experiencing difficulty in standing upright or having balance problems caused by thoracic kyphosis, our orthopedic spine specialist is ready to help. Dr. Matthew Hepler is an adult and pediatric spine surgeon Fort Lauderdale, Palm Beach County, and Delray Beach.

He treats all conditions of the cervical, thoracic and lumbar spine, and also provides spinal stenosis treatments. Additionally, he offers non-operative treatment options, such as pain medications, steroid injections, and physical therapy. He also offers operative treatments, including both minimally invasive techniques and complex reconstructions. If you would like to learn more about our orthopedic spine surgeon, please Contact Us.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.